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Inguinofemoral Dissection

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Abstract

Cutaneous melanoma and nonmelanoma skin cancer, malignancy of skin appendages, and some kind of soft-tissue sarcomas like epithelioid and clear cell sarcomas, localized in the lower body, perineum, scrotum, penis, vulva, and lower extremity, may metastasize to inguinal and less often pelvic lymph nodes. Nodal metastasis generally occurs unilaterally; however in the cases with midline localization of the primary tumor, it may be seen bilaterally.

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References

  1. Al-Refaie WB, Ross MI. Inguinal lymphadenectomy for malignant melanoma. Oper Tech Gen Surg. 2006;8(2):90–102. https://doi.org/10.1053/j.optechgensurg.2006.06.005.

    Article  Google Scholar 

  2. Badgwell B, Xing Y, Gershenwald JE, Lee JE, Mansfield PF, Ross MI, Cormier JN. Pelvic lymph node dissection is beneficial in subsets of patients with node-positive melanoma. Ann Surg Oncol. 2007;14(10):2867–75.

    PubMed  Google Scholar 

  3. Muthayya P, Miminas DA, Balakrishnan S, Dalvi Humzah M. Minimal access inguinal lymphadenectomy: a modified technique of groin lymph node dissection. J Plast Recontr Aesthet Surg. 2008;61(9):1126–8.

    Google Scholar 

  4. Poos HP, Kruijff S, Bastiaannet E, van Ginkel RJ, Hoekstra HJ. Therapeutic groin dissection for melanoma: risk factors for short term morbidity. Eur J Surg Oncol. 2009;35(8):877–83.

    CAS  PubMed  Google Scholar 

  5. Sarnaik AA, Puleo CA, Zager JS, Sondak VK. Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma. Cancer Control. 2009;16(3):240–7.

    PubMed  Google Scholar 

  6. Jacobs LK, Balch CM, Daniel Coit DG. Inguinofemoral, iliac/obturator, and popliteal lymphadenectomy in patients with melanoma. In: Balch CM, Houghton AN, Sober AJ, et al., editors. Chapter 22 Cutaneous melanoma. 5th ed. St Louis, MO: Quality Medical Publishing Inc; 2009. p. 460.

    Google Scholar 

  7. Coit DG. Radical groin dissection. In: Fisher JE, Kirby BI, editors. Mastery of surgery. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 1564–71.

    Google Scholar 

  8. Jakub JW, Reintgen DS, Shivers S, Pendas S. Regional node dissection for melanoma: techniques and indication. Surg Oncol Clin N Am. 2007;16(1):247–61.

    PubMed  Google Scholar 

  9. Erba P, Wettstein R, Rieger UM, Haug M, Pierer G, Kalbermatten DF. A study of the effect of sartorius transposition on lymph flow after ilioinguinal node dissection. Ann Plast Surg. 2008;61(3):310–3.

    CAS  PubMed  Google Scholar 

  10. Spillane AJ, Tucker M, Pasquali S. A pilot study reporting outcomes for melanoma patients of a minimal access ilio-inguinal dissection technique based on two incisions. Ann Surg Oncol. 2011;18(4):970–6.

    PubMed  Google Scholar 

  11. Zdzienicki M, Rutkowski P, Nowecki ZI, van Akkooi ACZ, Michej W, Dziewirski W, et al. The analysis of the outcomes and factors related to iliac-obturator involvement in cutaneous melanoma patients after lymph node dissection due to positive sentinel lymph node biopsy or clinically detected inguinal metastases. Eur J Surg Oncol. 2013;39(3):304–10.

    CAS  PubMed  Google Scholar 

  12. Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87(7):892–901.

    CAS  PubMed  Google Scholar 

  13. The NCCN GUİDELİNES. Clinical practice guidelines in oncology: melanoma (version 2) ©National Comprehensive Cancer Network, Inc. 2014. http://www.nccn.org. Accessed May 2014.

  14. Sabel MS, Griffith KA, Arora A, Shargorodsky J, Blazer DG 3rd, Rees R, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141(6):728–35.

    PubMed  Google Scholar 

  15. van der Ploeg APT, van Akkooi ACT, Schmitz PIM, van Geel AN, de Wilt JH, Eggermont AMM, Verhoef C. Therapeutic surgical management of palpable melanoma groin metastases: superficial or combined superficial and deep groin lymph node dissection. Ann Surg Oncol. 2011;18(12):3300–8.

    PubMed  PubMed Central  Google Scholar 

  16. Foote M, Burmeistera B, Dwyera P, Burmeisterg E, Lambied D, Allanj C, et al. An innovative approach for locally advanced stage III cutaneous melanoma: radiotherapy, followed by nodal dissection. Melanoma Res. 2012;22(3):257–62.

    PubMed  Google Scholar 

  17. van der Ploeg IMC, Valde’s Olmos RA, Kroon BBR, Nieweg OE. Tumor-positive sentinel node biopsy of the groin in clinically node-negative melanoma patients: superficial or superficial and deep lymph node dissection? Ann Surg Oncol. 2008;15(5):1485–91.

    PubMed  Google Scholar 

  18. Kretschmer L, Neumann C, Preußer KP, Wolfgang CH. Superficial inguinal and radical ilioinguinal lymph node dissection in patients with palpable melanoma metastases to the groin: an analysis of survival and local recurrence. Acta Oncol. 2011;40(1):72–8.

    Google Scholar 

  19. Esner R, Scheri R, Kavanagh M, Toriso-Itakura H, Wanek LA, Morton DL. Surgical management of the groin lymph node in melanoma in the era of sentinel lymph node dissection. Arch Surg. 2006;141(9):877–84.

    Google Scholar 

  20. Dzwierzynski WW. Complete lymph node dissection for regional nodal metastasis. Clin Plast Surg. 2010;37(1):113–25.

    PubMed  Google Scholar 

  21. Morton LM. Overview and update of phase III multicenter selective lymphadenectomy trials (MSLT-1 and MLST-II) in melanoma. Clin Exp Metastasis. 2012;29:699–706.

    PubMed  PubMed Central  Google Scholar 

  22. Martin BM, Master VA, Delman KA. Videoscopic inguinal lymphadenectomy for metastatic melanoma. Cancer Control. 2013;20(4):255–60.

    PubMed  Google Scholar 

  23. Pahwa HS, Misra S, Kumar A, Kumar V, Agarwal A, Srivastava R. Video endoscopic inguinal lymphadenectomy (VEIL) -a prospective critical perioperative assessment of feasibility and morbidity with points of technique in penile carcinoma. World J Surg Oncol. 2013;11:42–8. https://doi.org/10.1186/1477-7819-11-42. http://www.wjso.com/content/11/1/42.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nathansohn N, Schachter J, Gutman H. Patterns of recurrence in patients with melanoma after radical lymph node dissection. Arch Surg. 2005;140(12):1172–7.

    PubMed  Google Scholar 

  25. Mozzillo M, Caracò C, Marone U, Di Monta G, Crispo A, Botti G, et al. Superficial and deep lymph node dissection for stage III cutaneous melanoma: clinical outcome and prognostic factors. World J Surg Oncol. 2013;11:36. https://doi.org/10.1186/1477-7819-11-36.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Macripò G, Borgognoni L, et al. Number of excised lymph nodes as a quality assurance measure for lymphadenectomy in melanoma. JAMA Surg. 2014;149(7):700–6. https://doi.org/10.1001/jamasurg.2013.5676.

    Article  PubMed  Google Scholar 

  27. Coit DG, Peters M, Brennan MF. A prospective randomized trial of perioperative cefazolin treatment in axillary and groin dissection. Arch Surg. 1991;126(11):1366–71.

    CAS  PubMed  Google Scholar 

  28. Uzunismail A. Personal communication. 2014.

    Google Scholar 

  29. Plaxe SC, Braley PS, Dottino PR. A simplified approach to superficial inguinal node dissection with sparing of the saphenous vein in patients with carcinoma of the vulva. Surg Gynecol Obstet. 1993;176(3):295–6.

    CAS  PubMed  Google Scholar 

  30. Zhang SH, Sood AK, Sorosky JI, Anderson B, Buller RE. Preservation of the saphenous vein during inguinal lymphadenectomy decreases morbidity in patients with carcinoma of the vulva. Cancer. 2000;89(7):1520–5.

    CAS  PubMed  Google Scholar 

  31. Chang SB, Askew RL, Xing Y, Weaver S, Gershenwald JE, Lee JE, Royal R, et al. Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients. Ann Surg Oncol. 2010;17(10):2764–72. https://doi.org/10.1245/s10434-010-1026-z.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hinrichs CS, Gibbs JF, Driscoll D, Kepner JL, Wilkinson NW, Edge SB, et al. The effectiveness of complete decongestive physiotherapy for the treatment of lymphedema following groin dissection for melanoma. J Surg Oncol. 2004;85(4):187–92.

    PubMed  Google Scholar 

  33. Johnson DE, Lo RK. Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology. 1984;24(4):312–4.

    CAS  PubMed  Google Scholar 

  34. Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S. Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk factor analysis. Eur Urol. 2013;64(3):486–92.

    PubMed  Google Scholar 

  35. Gaarenstroom KN, Kenter GG, Trimbos JB, Agous I, Amant F, Peters AA, Vergote I. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Int J Gynecol Cancer. 2003;13(4):522–7.

    CAS  PubMed  Google Scholar 

  36. Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the MD Anderson Cancer Center Experience. J Urol. 2002;167(4):1638–42.

    PubMed  Google Scholar 

  37. Ahmed A, Saadadcharam G, Huisma F, Fogarty K, Mushtaque M, Shafiq A, Redmond R. Postoperative complications following nodal dissection and their association with melanoma recurrence. ISRN Surg. 2013;2013:6. https://doi.org/10.1155/2013/382138. Hindawi Publishing Corporation.

    Article  Google Scholar 

  38. Kissin MW, Simpson DA, Easton D, White H, Westbury G. Prognostic factors related to survival and groin recurrence following therapeutic lymph node dissection for lower limb malignant melanoma. Br J Surg. 1987;74(11):1023–6.

    CAS  PubMed  Google Scholar 

  39. Rapaport DP, Stadelman WK, Reintgen DS. Inguinal lymphadenectomy. In: Balch CM, Houghton AN, Sober AJ, et al., editors. Cutaneous Melanoma. 3rd ed. St Louis: Quality Medical Publishing; 1998. p. 269–80.

    Google Scholar 

  40. Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol. 2009;27(2):205–12. https://doi.org/10.1007/s00345-008-0324-6. Epub 2008 Sep 2.

    Article  PubMed  Google Scholar 

  41. Rouzier R, Haddad B, Dubernard G, Dubois P, Paniel BJ. Inguinofemoral dissection for carcinoma of the vulva: effect of modifications to the extent and technique on morbidity and survival. J Am Coll Surg. 2003;196(3):442–50.

    PubMed  Google Scholar 

  42. Tauber R, Schmid S, Horn T, Thalgott M, Heck M, Haller B, et al. Inguinal lymph node dissection: epidermal vacuum therapy for prevention of wound complications. J Plast Reconstr Aesthet Surg. 2013;66(3):390–6. https://doi.org/10.1016/j.bjps.2012.09.030. Epub 2012 Oct 26

    Article  PubMed  Google Scholar 

  43. Tonouchi H, Ohmori Y, Kobayashi M, Konishi N, Tanaka K, Mohri Y, et al. Operative morbidity associated with groin dissections. Surg Today. 2004;34(5):413–8.

    PubMed  Google Scholar 

  44. Wevers KP, Poos HP, van Ginkel RJ, van Etten B, Hoekstra HJ. Early mobilization after ilio-inguinal lymph node dissection for melanoma does not increase the wound complication rate. Eur J Surg Oncol. 2013;39(2):185–90.

    CAS  PubMed  Google Scholar 

  45. Denzinger S, Lübke L, Roessler W, Wieland WF, Kessler S, Burger M. Vacuum-assisted closure versus conventional wound care in the treatment of wound failures following inguinal lymphadenectomy for penile cancer: a retrospective study. Eur Urol. 2007;1(5):1320–5.

    Google Scholar 

  46. Tabatabaei S, McDougal WS. Primary skin closure of large groin defects after inguinal lymphadenectomy for penile cancer using an abdominal cutaneous advancement flap. J Urol. 2003;169:118–20.

    PubMed  Google Scholar 

  47. Nirmal TJ, Gupta AK, Kumar S, Devasia A, Chacko N, Kekre NS. Tensor fascia lata flap reconstruction following groin dissection: is it worthwhile? World J Urol. 2011;29(4):555–9.

    CAS  PubMed  Google Scholar 

  48. Schulze KA, Merrill DC. Use of scrotal skin to cover cutaneous defects resulting from palliative lymph node dissections in groin and suprapubic area. Urology. 1984;23:260–3.

    CAS  PubMed  Google Scholar 

  49. Judson PL, Jonson AL, Paley BJ, Bliss RL, Murray KP, Downs LS Jr. A prospective randomized study analyzing sartorius transposition following inguinal-femoral lymphadenectomy. Gynecol Oncol. 2004;95(1):226–30.

    PubMed  Google Scholar 

  50. Delman KA, Kooby DA, Ogan K, Hsiao W, Master V. Feasibility of a novel approach to inguinal lymphadenectomy: minimally invasive groin dissection for melanoma. Ann Surg Oncol. 2010;17(3):731–7.

    PubMed  Google Scholar 

  51. Sotelo R, Sanchez-Salas R, Clavijo R. Endoscopic inguinal lymph node dissection for penile carcinoma: the developing of a novel technique. World J Urol. 2009;27:213–9. https://doi.org/10.1007/s00345-009-0372-6.

    Article  PubMed  Google Scholar 

  52. Tobias-Machado M, Tavares A, Silva MN, Molina WR Jr, Forseto PH, Juliano RV, Wroclawski ER. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol. 2008;22(8):1687–991.

    PubMed  Google Scholar 

  53. Master V, Ogan K, Kooby D, Hsiao W, Delman K. Leg endoscopic groin lymphadenectomy (LEG procedure): step-by-step approach to a straightforward technique. Eur Urol. 2009;56(5):821–8.

    PubMed  Google Scholar 

  54. Karakousis CP. Surgical procedures and lymphedema of the upper and lower extremity. J Surg Oncol. 2006;93(2):87–91.

    PubMed  Google Scholar 

  55. Tiwari P, Coriddi M, Salani R, Povoski SP. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol. 2013;22:237. https://doi.org/10.1186/1477-7819-11-237.

    Article  Google Scholar 

  56. Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol. 1988;140:306–10.

    CAS  PubMed  Google Scholar 

  57. Milathianakis C, Bogdonos J, Karamanolakis D. Morbidity of prophylactic inguinal lymphadenectomy with saphenous vein preservation for squamous cell penile carcinoma. Int J Urol. 2005;12(8):776–8. https://doi.org/10.1111/j.1442-2042.2005.01137.x.

    Article  PubMed  Google Scholar 

  58. Dardarian TS, Gray HJ, Morgan MA, Rubin SC, Randal TC. Saphenous vein sparing during inguinal lymphadenectomy to reduce morbidity in patients with vulvar carcinoma. Gynecol Oncol. April 2006;101(1):140–2.

    PubMed  Google Scholar 

  59. Abbas S, Seitz M. Systematic review and meta-analysis of the used surgical techniques to reduce leg lymphedema following radical inguinal nodes dissection. Surg Oncol. 2011;20(2):88–96. https://doi.org/10.1016/j.suronc.2009.11.003. Epub 2009 Dec 11

    Article  PubMed  Google Scholar 

  60. Willis AI, Moley JF. Complications of lymphadenectomy. In: Mulholland MW, Doherty GM, editors. Complications in surgery. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2012. p. 602–12.

    Google Scholar 

  61. Gould N, Kamelle S, Tillmanns T, Scribner D, Gold M, Wilker J, Mannel R. Predictors of complications after inguinal lymphadenectomy. Gynecol Oncol. 2001;82(2):329–32.

    CAS  PubMed  Google Scholar 

  62. Hacker N, Leuchter R, Berek J, Castaldo TW, Lagasse LD. Radical vulvectomy and bilateral inguinal lymphadenectomy decreases postoperative morbidity in vulvar cancer patients. Obstet Gynecol. 1981;58(5):574–9.

    CAS  PubMed  Google Scholar 

  63. Lawton G, Rasque H, Ariyan S. Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinal lymphadenectomy for melanoma. J Am Coll Surg. 2002;195(2):339–51.

    PubMed  Google Scholar 

  64. Gilly FN, Francois Y, Sayag-Beaujard AC, Glehen O, Brachet A, Vignal J. Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer. Eur Surg Res. 1998;30(6):439–43.

    CAS  PubMed  Google Scholar 

  65. Buda A, Fruscio R, Pirovano C, Signorelli M, Betti M, Milani R. The use of TachoSil for the prevention of postoperative complications after groin dissection in cases of gynecologic malignancy. Int J Gynecol Obstet. 2012;117(3):217–9.

    Google Scholar 

  66. Swan MC, Oliver DW, Cassell OC, Coleman DJ, Williams N, Morritt DG, Giele HP. Randomized controlled trial of fibrin sealant to reduce postoperative drainage following elective lymph node dissection. Br J Surg. 2011;98(7):918–24.

    CAS  PubMed  Google Scholar 

  67. Carlson JW, Kauderer J, Walker JL, Gold MA, O’Malley D, Tuller E, Clarke-Pearson DL. A randomized phase III trial of fibrin sealant to reduce lymphedema after inguinal lymph node dissection: a Gynecologic Oncology Group study. Gynecol Oncol. 2008;110(1):76–82.

    CAS  PubMed  Google Scholar 

  68. Kim HY, Kim JW, Kim SH, Kim YT, Kim JH. An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies. Cancer Res Treat. 2004;36(6):377–83.

    PubMed  PubMed Central  Google Scholar 

  69. Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema a comprehensive review. Ann Plast Surg. 2007;59(4):464–72.

    CAS  PubMed  Google Scholar 

  70. Boccardo F, De Cian F, Campisi CC, Molinari L, Spinaci S, Dessalvi S. Surgical prevention and treatment of lymphedema after lymph node dissection in patients with melanoma. Lymphology. 2013;46(1):20–6.

    CAS  PubMed  Google Scholar 

  71. Greene AK, Slavin SA, Borud L. Treatment of lower extremity lymphedema with suction-assisted lipectomy. Plast Reconstr Surg. 2006;118(5):118e–21e.

    PubMed  Google Scholar 

  72. Arbeit JM, Lowry SF, Line BR, Jones DC, Brennan MF. Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma. Ann Surg. 1981;194(5):648–55.

    CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Sıdıka Kurul .

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Kurul, S., Uzunismail, A., Tuncer, S., Karanlık, H. (2020). Inguinofemoral Dissection. In: Papadopoulos, O., Papadopulos, N.A., Champsas, G. (eds) Non-Melanoma Skin Cancer and Cutaneous Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-030-18797-2_26

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  • DOI: https://doi.org/10.1007/978-3-030-18797-2_26

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